Provider Demographics
NPI:1417621848
Name:CARLSSON, GREG ARTHUR (LMFT)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:ARTHUR
Last Name:CARLSSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91102-0147
Mailing Address - Country:US
Mailing Address - Phone:626-399-1966
Mailing Address - Fax:
Practice Address - Street 1:301 E COLORADO BLVD STE 807
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-6106
Practice Address - Country:US
Practice Address - Phone:626-356-7519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist